M TRCING BENH VIEN Triin

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T 6 N G Q U A N - REVIEWS

H 6 A C H A T KHl> TRUNG TRONG P H 6 N G C H 6 N G

BENH TRUYEN NHigM & CONG D 6 N G V A N H | £ M TRCING BENH VIEN

Triin Quang Huy*, Nguyen Thanh Thuy, Pham Ngpc Dinh Vi^n Vf sinh Dich te Trung uvng, Hd Ngi

TOM TAT

B$nh tnjyen nhiem (BTN) a c<Jng dfing vt nhiSm trCing b0nh vi§n (NTBV) dang IS mOt trong nhCrng van Qh dup'c quan tdm hdng d^u cua nganh y t^ va cua todn xa hOi Vi^c sO dgng chJit khCr tnjng (KT) d l g6p ph^n ng5n ch^n sy lay lan ciia tfic nhfln gSy BTN vfl ph6ng ch6ng NTBV Ifl y^u t6 quan trpng giflm thilu thi^t hai v^ sijc kh6e cpng dong cung nhir nhij'ng tflc dpng tieu cyc doi vdi nen kinh te xa hpi Tren thj tru'd'ng c6 reit nhifiu sfln phim khCc triJng du'p'c quflng cflo c6 khfl nflng diet t6i 99,9% vi khuin phfi r^ng, nim, nha bao va virus Tuy nhi§n, nhfrng thong tin vfl hieu biet ve ca che tflc dpng doi v6i vi smh gay b^nh, d$c tinh cCia tii'ng chdt khir triing nfly dfii vdi ngudi vfl h@ smh thfli nhu- the nflo vlin cdn rat han chfi.

Bfli tong quan nfly nham cung cip nhCrng thong tin thifit yfiu ve cflc chfit khip triing truyen thong cung nhu' cac chfit khir trting the h# mdi trong vi#c ngfln chgn dich b#nh truyen nhiem va nhiem trting bpnh vipn Tip khoa: Hoa chat khd triing, nano bac, b^nh truyen nhiem, nhiem triing benh vi#n, co' chfi khd trung.

L BAT VAN B E

Ngay nay, vdi sir phat trien vl kinh te va toe dp loan cau boa dien ra nhanh chdng thi cac loai BTN moi noi va tai bung phat cflng khong ngiing tang, mang nhilu yeu td bat ngd nhu su bien chung, dpc tinh cao hay tdc dp lay lan manh, anh hudng nghiem trpng tdi sue khde cpng dong va thiet hai ve kinh te- xa hpi [1, 2].

Dong Nam A la khu vuc thudng xuyen phai ddi mat va tiem an nguy ca xay ra cac vu dich nguy hilm nhu vigm dudng ho hip ckp tinh nang (S ARS), cum A/H5N1, cum A/H IN1 dai dich, sdt xuat huylt Dengue, viem nao, tay- chan- mieng, benh ta... [2, 3], Trong 10 nam trd lai day, khu vuc nay chiu tac dpng cua cac vu dich ldn do virus nhuNipah (1998 - 1999) [4], vigm dudng ho hap cAp tinh nang - SARS (2002- 2003) [5], cum A/H5N1 (2004 din nay) [6], cum A/HINI (2003 din nay) [7]; gin day la nguy ca dich ciim A/H7N9 tu Trung Qudc [8]

va hpi chung vigm dudng ho hap tu Trung D6ngdoMERS-CoV[9].,.

0 Viet Nam, sd benh truyen nhiem do virus CO xu hudng tang nhu thuy dau tu 39.753 ca trong giai doan 1990- 1999 len 129.745 cagiai doan 2000 - 2009 (tang 2,3 ISn), benh quai bi tang 29,8%; dich sdt xuat huyet Dengue tang manh trong nam 2008 - 2009 vdi hang chuc nghin ca mac benh; vu dich ciim A/HlNl-09 co 2.069 ca ducmg tinh dupc xet nghiem tai Vien Ve sinh Dich te Tmng uong tii cac mau benh pham thu thap d mien Bac, trong do cd 15 ca tu vong tinh den het nam 2009, Tu nam 2003 den nam 2011, raien Bac Viet Nam da cd 77 ca benh duoTig tinh vdi virus A/H5N1, trong dd 32 ca tu vong (ty le chit/mac la 41,6%) [10]. Nam 2011-2012, dich tay-chan-mieng ldn nhat tu:

trudc tdi nay da xay ra tren toan qudc vdi 174.677 trudng hop bi mac va 200 trudng hpp tli vong [11]. Theo udc tinh cua ngan hang phat trien chau A (ADB) [12], chi phi cho djch SARS

* Tac gia: Tran Quang Huy

Dia chi: Vien Ve sinh dich te Trung uong Dien thoai: 84.4.39715434 /0978960658 Email: [email protected]

Ngaynhanbai: 5/3/2013 Ngay gui phan bien: 15/3/2013 Ngay dang bai: 6/6/2013

Tap chi Y hpc dir phdng. Tap XXIII, sd 3 (139)

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d Ddng Nam A khoang 18 ty do la My, trung binh khoang 2 tri^u dd la My/ngudi bj nhiem, chi phi n^y dupc tinh cho ca nhimg thi$t hai lien quan den su giam sut cua nganh cdng nghi?p dich vu va du ljch. Nam 2006, Ngan hang Thg gidi cung da udc dnh neu xay ra mpt dai djch cum se tieu tdn khoang 1,25 den 2 nghin ty do la My [13]. Chi tinh rieng vu dich ciim A/H5N1 xay ra nam 2003 - 2004, Vict Nam da phai thieu huy gkn 45 tri$u gia cam, udc tinh thi?t hai len din 118lri?ud61aMy[14].

Ben c^uih d6, nhiem khuan tai b?nh vi?n cflng la mpt trong nhiing thach thuc va moi quan tam hang dau tai Vi$t Nam cung nhu tren loan the gidi. Moi nam co khoang 2 trieu b?nh nhan bi nhilm tning b?nh vien (NTBV) va gSn 100.000 ngudi trong so do tu vong, chi phi cham sdc siic khde cho benh nhan NTBV hang nam len tdi 4,5 ty do la My [15, 16]. Dac biet, trong moi trudng benh vien, ngay cang xuat hien nhieu chiing vi khuan khang khang sinh tiem an, nguy ca lay nhiem cao, gay kho khan trong viec phdng tranh va dieu tri cho benh nhan [17], Mpt sd hda chat khu tning thuong dupc su dung de ngan chan dich benh va NTBV nhu cloramm B, glutaraldehyde, formaldehyde hay con... da gdp phan dang ke trong viec lam sach mdi trudng benh vien va cpng dong. Tuy nhien, pban ldn cac chat khu trung dang dupc su dung hien nay deu it nhigu CO dpc tinh doi vdi ngudi va he sinh thai d nong dp nhat dinh khi tiep xuc trong thdi gian dai. Mpt so san pham khu trung hay chiia chat khir trung tren thi tnidng Viet Nam hien nay dupc quang cao CO kha nang diet 99,9% vi khuan pho rpng, nha bao va vims, nhung phin ldn cac san pham nay dlu thilu cac minh chiing cu the. Han nu'a, hilu bilt vg ca chl tac dpng cua cac chat khii tning con ban chg nen viec su dung tran lan cac san pham chiia chat khu tning cdn cd kha nang lam tang nguy co khang lai chinh cac chat khu tning nay va tang tinh khang thuoc cua cac lo^i vi sinh gay benh. Muc dich cua Tdng quan nay

nhim cung ckp va c^p nhSt mpt s6 thdng tm cho dpc gia vl lpi ich, ca chl tdc dpng cung nhu nhirng thach thUc trong vi^c siJr dung cac chSt khu tning doi vdi cac b?nh tmyin nhiem d cdng ddng va nhilm tning b?nh vi?n.

II. NQI DUNG 2.1 Ngudn ISy truyin b^nh

Rit nhilu tac nhan gay BTN cd the ton. tai lau dai trong mdi trudng va sin sang gay benh cho ngudi hay dpng vat khi cd sy tigp xiic true tilp hay gian tilp thdng qua vat chii trung gian.

Ndi each khac, ngudi hay dpng vat cd thg bi nhilm b?nh tir moi tnrdng nudc, khdng khi, thuc pham, dung cu ca nhan hay bi cdn triing dot [18-20]. Khdng khi la mdi trudng tmyen benh ciia hem 20 loai vi khuan gay viem nao, vigm dudng bo hap, lao hoac tieu chay; cua cac loai virus nhu adeno; corona; coxsackie; ciim;

a cum; echo; rhino; reo; toga; hap bao dudng hd hap; thiiy dau... va mpt sd loai nim nhu aspergillus; Pneumocystis carinii; crypcoccus neoformans [21]. Nuac ciing la mdi tnrdng tmyen benh cua rat nhieu mam b?nh lien quan den dudng tieu hda, trong do cd phay khuin ta, cac loai vi khuan nhu Campylobacter spp.. Es- cherichia coli (E.coli). Legionella pneumophila, Salmonella spp.; cac vims nhu viem gan A, nero va entero... [11, 22]. Mpt sd mim benh ciing cd thg lay tmyin qua thuc pham nhu vi khuan Campylobacter, E. coli. Salmonella hay Shigella [23]. Ngoai ra, mau cung la dudng tmyin thich hop cua mpt so virus nhu HIV, virus viem gan B, virus viem gan C [24]. Mim b?nh cd thi ton tai trong cac moi truang tren va/hoac bam dinh len bl mat nao do d dilu kien nhit dinh. Trong mpt cong trinh cdng bd nam 2006 [25], Kramer da tdng hop cac cdng trinh nghign ciiu va chi ra mam benh bam dinh tren bl mat v|t rin kho rao va khong c6 chat dinh duang cd thi ton tai tir vai gid den vai thang (bang 1, bang 2).

10

Tap chi Y hpc du phdng, Tap XXIII, sd 3 (139)

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Bang 1. Tho-i gian vi khuin vd nim gfiy b^nh ton t^i trdn b l m$t v^t r^n khd [25]

Thcfi gian tSn t?t Vi khuin

Acinetobacter spp.

BordeteUa pertussis Campylobacter jejuni Clostridium diddle (spores) Chlamydia pneumoniae. C. trachomatis Chlamydia psittaci

Corynebacterium diphtheriae Corynebacterium pseudotuberculosis Eschenchia coli

Enterococcus spp.

Haemophilus influenzae Klebsiella spp.

Mycobactenum bows Neissena gonorrhoeae Pseudomonas aeruginosa Salmonella typhimurium Senratia marcescens Helicobacter pylori Listena spp 1 Mycobacterium tuberculosis Proteus vulgaris Salmonella typhi Salmonella spp.

Shigella spp.

Staphylococcus aureus, gom ca /WRSA Streptococcus pyogenes Staphylococcus aureus, gam ca MRSA Vibrio cholerae

3 ngdy tdi 5 thdng 3 - 5 ngfly tdi 6 ngSy 5 thflng s 30 gid 15 ngciy 7 n g f l y - 6 thflng 1-8 ngSy 1 , 5 g i d - leth^ng 5 ngay - 4 thflng 12 ngfly 2 gid >30 thflng

>2 thflng 1-3 ngdy

6 gid-16 thang, tren san: 5 tuan 10 ngfly-4,2 nam 3 ngfly - 2 thflng, tren san. 5 tu§n s 90 phOt

1 ngfly den hflng thdng 1 n g a y - 4 thdng 1-2 ngdy 6 g i d - 4 tuan 1 ngay 2 ngfly - 5 thang 7 ngfly - 7 thflng 3 ngfly - 6,5 thflng 7 n g f l y - 7 thflng 1 - 7 ngay

Nim Candida albicans Candida parapsilosis Toruiopsis glabrata

1 - 1 2 0 ngay 14 ngay 102-150 ngdy Trong dieu kien thuan lai, cac tac nhan gay

dich BTN va NTBV co thi ton tai tren bl mat khd rac trong nhilu thang. Han ntra, Viet Nam

la nudc nhi?t ddi am, gid miia nen phii hop cho nhieu loai mam b?nh tmyin nhilm sinh truang va phat trien.

Tap chi Y hpc du phdng, Tap XXIII, sd 3(139)

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Lo^i virus

Bdng 2. Thai gian t i n t?! cua virus tren tik m$t v|lt rin kh6 [25]

Thd'i gian t6n t^i Virus adeno

Virus astro Virus corona SARS -Gov Virus coxsackie Virus cytomegalo Virus Echo Virus vi§m gan A Virus vigm gan B HIV

Virus herpes simplex t«?p 1 vd 2 Virus cdrn

Virus noro vd virus feline calici (FCV) Virus papilloma

Virus papova Virus parvo Virus polio typ 1 Virus polio typ 2 Virus pseudorabies

Virus hop bdo du'dng hd h i p (RSV) Virus rhino

Virus rota Virus vacinia

7 ngdy - 3 thdng 7 - 9 0 ngdy 3 gid 72 - 96 gid

> 2 tuin 8 gid 7 ngdy 2 gid - 60 ngdy

>1 tuin

>7 ngdy 4,5 g i d - 8 tuin 1 - 2 ngdy 8 gid - 7 ngdy 1 6 - > 7 n g d y 8 ngdy

>1 nam 4 - < 8 ngdy 1 - 8 tuan a 7 ngdy Den 6 gid 2 gid - 7 ngdy 6 - 6 0 ngdy 3 - 2 0 tuin

2.2 Chat khv triing truyen thong Nham ngan chan sir lay truyin cua cac mim benh tren, rit nhilu loai chit khu tning da dupc su dung trong cac benh vien, ca quan to chiic y te, trudng hpc, khu sinh hoat cong cpng, hp gia dinh va nhiing khu vuc khac nham bao vp siic khoe cpng dong. Nhiing hda chat khii triing thudng dupc sir dung nhu cdn, cloramin B, formaldehyde, hpp chat thupc nhdm biguanides, hop chit thupc nhdm halogen, cac chat d-xy hda cao...[26, 27]. Bang 3 md ta ca chg tac dpng, uu diem, nhupc diem va boat tinh khang/diet vi sinh cua mot s6 chat kbii triing truyen thing trong phdng chong BNT va NTBV.

Mpt so hda chat thdng diing nhat dupc md ta tdm tat dudi day:

Con: Mpt sd loai con da dupc chiing minh cd tinh khang vi sinh phd rpng mpt each hieu qua nhu con ethanol, con isopropyl. Cdn cd kha nang tieu diet vi khuan, nam va vims mpt each nhanh chong nhung khdng diet dupc nha bao

[28]. Ca che khang vi sinh vat cua con dua tren su pha huy mang tg bao va nhanh chdng lam bign tinh cac thanh phan protein. Cdn cd boat tinh khang vi sinh tdi uu d nong dp trong khoang 60 - 90% va giam ban khi ndng dp nho ban 50%!. Hoat dnh khang vi sinh v^l ciia cdn ethanol m^nh hem cdn isopropyl. Do dl bay hai va de chay ngn con khdng dupc sir dyng de khii tning 6 nhimg khu v\rc cd dien tich ldn va gan cac ngudn nhi$t cao.

Glutaraldehyde: Glutaraldehyde la mpt chat cd hai nhdm chiic aldehyde, dupc sii dpng nhu mpt chat khii triing trong chdng NTBV, d?c biet la khu Ining cac dng npi soi va thilt hi phlu thuat [29]. Glutaraldehyde co kha nang chdng lai hau bet cac logi vi khuan, nam, nha bao va virus gay benh.

Formaldehyde: Formaldehyde la chat co chiia mpt nhdm aldehyde cd boat tinh diet khuan, nim, nha bao va virus cao, nhung ch?m ban so vdi glutaraldehyde [30, 31].

12 Tap chi Y hpc du phdng. Tap XXIII, s6 3 (139)

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B a n g 3 . Q $ c t i n h cCia m $ t s o c h i t k h u t r i i n g t r u y i n t h 6 n g [ 2 6 , 2 7 ]

P h a n l o ^ i L Ten sfln phSm . ^ " ^ n U " " * ^ " " N h i r f c d i e m

H09t l i n h k h d n g / d i ^ t v i s i n h v$t gSy b^nh

Vi khudn N^m Nha bdo

- Ethanol - Isopropanol

Kitti-ianm TflC (J^ng

t \ e u u a p r o - p^gnh loai Bay hoi nhanh I f ' " ^ . " bfi cflc c h i t khfi da d§ chfiy

j H i # u qufl

Hi$u qufi vdi Khflng v i n j s c 6 v 6 , hi$u han c h l vdi qufl m^t s6 virus khflng c6 v6

B i l n tinh Gfly ung t h u k(ch Ceng

Glutaraldehyde protein alkyl D i f t d dfli mfl vfl mgch mflu chi j . . . . Hi#u Hi$u -Formaldehyde hfla axil

cleic

si> dgng d nhOng khu VU'C thflng thofi ng

- ChIo J e x i d i n e ^ ^^^ ^^- . - A « x i d i n e . t h i m l h i u ° ' ^ * ^ ^ ^ ' pH 5-7 ( ^ th4 finh H i f u qufl ^^"

biduanides mflng t l bfio ^ hu'dng tdi mfli tru'dng

KhOng hi$u H^n che qufi

Halogens: - Cloramin B, T B i l n tinh hypoclorites - Chat t l y trang protein

Bi mat hoat tlnh bdi _ , . .. i n h sfing mgt Irdi thdi

° gian hogt dong ngan rongino-i |j,m mfln kim loai kich ^ . . , Hieu gian ^ep xuc ^^ ^^ ^^^^ ^^^ Hi^u qua ^ ^ . S f "h i khflng nen pha l l n vdi manh re ^^^^ ^ j ^ . ^^^- ^ ^ ^ ^ g

khi cio d6c

- 6 xy gia protein vfi Di^t dai rflng hpit

C6 t h i lam hflng mpt s6 kim loai

Hpp chat - Hop c h i t chda Tu'crng tfic chda cua bgc vdi nhom _ kim loai - Ho'p chat chda thiol, dc che n|ng thuy ngan enzym

Cfl the doc vdl ngu'di va h§ sinh thfii khi tiep xuc vdi muoi bgc d Hi§u qufi nong do cao trong thdl gian dai

Hi6u Chu'a qua ro

„.. „ . LU'U g i s l n Bien tmh , uTua.,^

i dmh khflng H(?p c h i t - Cetrimide, ben- g ' ^ ^ " ^^" kich * n g da amonium t d zaikonium chIo- „ , L , „ I : „ : , hi^u tl^fi d phan (QAC) rite ^ J f ^ ^ ^ ^ J nhig. dp cao

cua mang le ^ ^ ^^ ^ ^ ^ (9-10) bfio

Higu qua (Gram +), hgn Trung c h l binh (Gram am)

Trung binh vdl vims CO ' vfl khflng

hi$u qufi v d l virus khflng cfl vo

f Higu qufi vdi p m t e i n . 4 KhSng 5n C6 the g a , kich mig |<l]'>"9 T l m n g ™ thay doi dp mdn luu giu' da va mat co the dpc Hipu qua . . " higu i,i u ^ - ' - '-•'•• * - " - " vdi ddng vat ' " " " qufi ^ ' " " 'f?'.

" • ^ virus khong cfl vo Phenols va - Phenol

Cresols - Cresol t h i m t h i u on dmh thdnh te bfio

Tap chi Y hpc du phdng. Tap XXIII, sd 3 (139) 13

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Cloramin vh c^c hda chat chira elo boat tinh: Day la nhdm hda chat co boat tinh d-xy boa khu cao, thudng dupc su dpng de khii tning be mat, dd vai, cao su, do thiiy tinb va nudc sinh hoat khdi cac miim benh truyen nhiem. Clo- ramin cd boat tinb di?t vi khuan, nam va virus cao, gia thanh re. Tuy nhien chi cd kha nang phat huy tac dung trong Ihdi gian ngan do ion c r de bi phan buy dudi tac dyng ciia anh s^ng [32], Cac boa cbSt cd cbiia d o thudng sir dyng bao gom: Cloramin B ham lupng 25 - 30% elo hoat dnh (cdn gpi la CloraminB), Cloramin T, Canxi hypocloride (Clorua vdi), bpt Natri dichloroisocianurate, nuac Javen (Natri hypocloride hoac Kali hyphocloride). Trong cong tac phdng chdng dich, cac dung djch pha tli cac hda chat chiia cio vdi ndng dp 0,125%;

0,25%; 0,5% va 1,25%, 2,0% d o boat tinh thudng dupc sir dung tiiy theo muc dich va each thiic ciia viec khu tning. Viec tinh nong dp dung dich phai dua vao ty le cio hoat tinh [33].

2.3 Mot so san pham khu triing thi h^ moi Hien nay con ngudi sit dung rdt nhigu loai hda chat khii tning vao muc dich ngan chan su lay ian, phat tan cua vi smh gay benh va lam sach mdi trucmg. CJ nudc ta, cloramin B dupc Bp Y te khuyen cao sii dung de khii tning nhiing khu vuc nghi ngd cd mam benh truyen nhiem va vat dung lien quan. Nhu da de cap d tren, gia thanh hda chat nay re, co phd diet khuan rpng va de sii dung, nhung thdi gian hoat dpng ciia hda chat nay ngkn, de bi mat ho^t tinh dudi anh sang mat trdi nen kha nang bao ve bi han che theo thdi gian, dac biet khdng diet dupc nba bao. Trong khi do, sd tac nhan vi sinh cd kha nang tao nha bao va bao tii rat nhieu va cd thg tdn tai 6 mdi trudng trong nhiing thdi gian dai, CO khi tdi nhieu nam [25], do vay ca hpi dg tai nhifim tning sau khi mdi trudng dupe khii tning bang hoa chat nhdm nay la khd tranh kbdi. Con cac hda chat sii dyng dg khir tning trong NTBV thudng cd dpc tinh cao hoac r^t cao, mpt so hda chat cd kha nang gay ung thu khi tigp xiic vdi ndng dp cao trong thdi gian dai [15]. Do vay, viec nghien ciiu va phat trign nhiing san pham khu tning the he mdi than thien vai mdi truang, cd kha nang diet dupc cac loai vi sinh vat gay benh cung nbu nba bao, bao 14 Tap chi Y hpc dir phdng,

tir nhung it dpc tinh vdi ngudi va mdi trudng la van de cap thiet.

Tuy nhien g^n day chua cd nhigu nhihig cdng bo vg cac hda chat khir triing the hp mai hudng tdi iing dyng trong phdng chdng dich BTN va NTBV. Noi len phai kg tdi mpt s6 cdng trinh dang dupc tign hanh, lign quan den vi^c tao ra nhirng san pham khii tning nano, trong dd nano b?c la iing cir vien hang dau. San pham khu tning dya tren nano bae dupc ky vpng c6 the bii dap dupc nhiing nhupc digm cua cac ohSt khu triing tmyen thdng. Nam 2005, Morones v^

cpng su [34] cdng bd ve tinh khang khuan cua nano b^c d kich thudc 1-100 nm. Nghign curu nay chi ra riing tinb khang khuan ciia nano bgc phy Ihupc vao kich thudc va chi cd nhimg hat cd kich thudc I-10 nm mdi tuang tac true tiep va pha hiiy thanh te bao vi khuan. Khi khao sat tinh khing khuan va nam ciia cac hat nano bac cd kich thudc trung binh 13,5 nm, kgt qua cho thiy ndng dp lie chg tdi thieu ciia nano bac doi vdi nam, > 6,6 nM; E. coli: 3,3 nM va S.aureus:

> 33nM [35], Farinha va cpng sy [36] ciing thdng bao ket qua quan sat trong 15 phiit v^ khi nang dipt mpt sd chung vi khuan gay b?nh ciia nano bac d nong dp 15 ppm va 30 ppm . Chimg S.aureus, P. aeruginosa. S. typhimurrium. C. Al- bicans, E.faecalis bi tieu diet hoan toan 4 phiit sau khi tiep xiic vai ndng dp nano bac 30 ppm va 15 phiit vdi ndng dp nano bac 15 ppm. Day la nhiing thdng sd rSt an tupng ve kha nang di?t khuan cua nano bac. Rai va cpng sy [37] cho rang nano bac cd kich thudc 10 - 100 nm la vii khi nano buy diet dg chdng lgi nhirng ehung vi khuan gay benh "ngoan c6" (Vi khuan Gram am. Gram duang khang thudc).

Ngoai ra, nbdm nghign ciiu ciia Giao su Oule, Trudng Dai bpc Saint-Boniface, Canada [38] gan day da cdng bd cong trinh nghign cihi vg chat khir triing thg h? mdi dua tren hda chat Polyhexamethylene-guanidine hydrochloride (PHMGH) cd kha nang diet nha bao va cac cbiing VI khuan gay NTBV trong thdi gian vai phiit vdi ndng dp thSp co 1/1000 [39]. Akwaton la ten san pham khir tning da dupc phat trien dua tren nhirng nghign ciiu nay, san phSm khdng mau, khdng mui, khdng an mdn vat dung va khdng dpc hgi, san phSm cung cd thg duac Tap XXIII, so 3 (139)

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sii dyng ngay tgi cdc benh vien hay 6 nbi [39].

Nhin chung, tat ca nhung san pham hda chit khli triing thg he mdi khi nghien cuu va phat trien deu phai dam bao kha nang diet vi sinh gay b$nh pho rpng trong thai gian ngan, bao gom ca nhiing chung khdng thudc, nha bao va virus nhung vln phai than thien voi moi trudng va it dpc hgi tdi ngudi va h§ sinh tbdi.

III. KET LUAN

Bai tdng quan nay dg cap tdi mpt so boa chat, che phdm kbii tning thudng dupc sir dyng trong phdng chong dich b?nb truyen nhiem va ngan ngiia nhilm triing benh vien. Ben canh do, nhiing thong tin ve thdi gian tdn tai cua mam benh trgn be mat kho ciing dupc dua ra de lam ro hem vai trd va ca che tac dpng ciia cac chat khli triing nham loai bd nhiing mam benh nay.

Bai tdng quan ciing tom luac mot so hudng nghien ciiu va phat trign ciia nhiing chat khit triing the he mai dua tren nano bgc va Poly- hexamethylene-guanidine hydrochloride cd tinh nang diet vi sinh gay benh va nha bao d pho rong trong tbdi gian ngan nhung vln dam bao yeu td than thien vdi moi truang va it dpc hai tdi Slic khoe con ngudi cung nhu he sinh thai.

TAI LIEU THAM KHAO

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DISINFECTANTS FOR THE PREVENTION OF INFECTIOUS DISEASES AND NOSOCOMIAL INFECTIONS

Tran Quang Huy, Nguyen Thanh Thuy, Pham Ngoc Dinh National Institute of Hygiene and Epidemiology, Hanoi Infectious diseases and nosocomial infections

are the leading concerns in the health sector and whole society. The use of disinfectants for tbe prevention of infectious diseases and nosocomial infections is a key factor to minimize the lost to public health as well as the negative impact on socio-economy. There are many com- mercial products advertised as powerful disinfectants that can kill 99.9% of bacteria spectrum, fiuigi, spores and vimses but without

the evidence. However, the infonnation and un- derstanding of the mechanism of antimicrobial action, toxicity of the disinfectant to human and ecosystem are still very limited. This review aims to provide essential information on the tra- ditional disinfectants as well as their new gen- eration in the prevention of infectious diseases and nosocomial infections.

Keywords: disinfectant, infectious disease, nosocomial infection, preventive medicine

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